Don’t Ask Your Doctor About ‘Low T’

SANTA BARBARA, Calif. — A FUNNY thing has happened in the United States over the last few decades. Men’s average testosterone levels have been dropping by at least 1 percent a year, according to a 2006 study in The Journal of Clinical Endocrinology and Metabolism.

Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further, especially in obese men. Drugs like steroids and opiates also lower testosterone, and it’s suspected that chemicals like bisphenol A (or BPA, commonly found in plastic food containers) and diseases like Type 2 diabetes play a role as well.

Men feel the loss. Clinical testosterone deficiency, which is variously defined as lower than 220 to 350 nanograms of testosterone per deciliter of blood serum, can cause men to lose sex drive and fertility. Their bone density often declines, and they may feel tired and experience hot flashes and sweats.

But “low T,” as the condition has been labeled, isn’t nearly as common as the drug ads for prescription testosterone would have you believe.Pharmaceutical companies have seized on the decline in testosterone levels as pathological and applicable to every man. They aim to convince men that common effects of aging like slowing down a bit and feeling less sexual actually constitute a new disease, and that they need a prescription to cure it. This is a seductive message for many men, who just want to feel better than they do, and want to give it a shot, literally.

The problem is that prescription testosterone doesn’t just give your T level a boost: it may also increase your risk of heart attack. It can add huge numbers of red blood cells to your bloodstream and shrink your testes. In some men, it increases aggression and irritability. Children who accidentally come in contact with the hormone can develop unwanted pubic hair and genital changes. Last week, a large study published in the journal PLoS ONE found that, within three months, taking the hormone doubled the rate of heart attacks in men 65 and older, as well as in younger men who had heart disease. The Food and Drug Administration has begun an investigation.

The number of testosterone prescriptions given to American men has tripled since 2001. Used clinically since 1937 and approved by the F.D.A. since 1953, testosterone is now administered in at least five forms, including patches, gels and injections. Three million prescriptions were written in 2012 for the market leader AndroGel alone. Sales of all testosterone-boosting drugs are estimated to have been $2 billion in 2012, and are projected to hit $5 billion by 2017.

Too many doctors are now writing testosterone prescriptions without even measuring the patient’s hormone levels, much less re-testing for confirmation and adjusting the dose after prescription. Up to a quarter of these prescriptions are dispensed without a blood test.

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From a psychological perspective, this isn’t helping men. From a medical perspective, it’s devastating. In addition to the cardiac risks, prescription T can mean a permanent shut-off in men’s own, albeit diminished, testosterone production. In other words, once you start, you may well be hooked for life.

Instead of heading to the pharmacy to get their fix, men should address the leading cause of the problem.Losing weight is a tried and true way to naturally boost testosterone levels. According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. In general, a man’s waist should be half his height.

Some diet changes may be useful for reasons other than just weight loss. If you drink too much booze, switch to water — alcohol lowers testosterone levels. Eating more cruciferous vegetables like broccoli and collard greens can also help, by blunting the effects of estrogen in a man’s body. At the end of the day, eating more of the right foods and fewer junk foods improves mood and energy — which may be the only fix many men need.

In the 1990s and early 2000s, middle-aged women went through their own hormone trial, taking synthetic prescription estrogen and progesterone to treat the symptoms of menopause, among other reasons. But by 2002 we knew that those hormones raised the risk of stroke, heart disease, life-threatening blood clots and invasive breast cancer in healthy women.

Luckily, we don’t have to wait 12 more years to learn about the risks of testosterone in healthy men. Men have been drugged by overprocessed foods and gender-bending chemicals like BPA. The last thing they need now is a prescription for a risky drug to treat a trumped-up disease.

John La Puma is an internist and the author of “Refuel: A 24-Day Eating Plan to Shed Fat, Boost Testosterone, and Pump Up Strength and Stamina.”

A version of this op-ed appears in print on February 4, 2014, on Page A21 of the New York edition with the headline: Don’t Ask Your Doctor About ‘Low T’. Today's Paper|Subscribe